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General NPI Number Information
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NPI Number | 1609236025
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Entity Type | Organization
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Legal Business Name | MICHELLE'S CARE HOME
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Dates
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Enumeration Date | 02/26/2016
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Last Update Date | 05/26/2016
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Provider Practice Location Address
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Address Line | 1310 POPLAR ST
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City | JOURDANTON
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State | TX
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Zip | 78026-2239
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Country | US
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Telephone | 830-767-3082
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Fax | 830-767-3082
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Provider Business Mailing Address
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Address Line | 1310 POPLAR ST
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City | JOURDANTON
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State | TX
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Zip | 78026-2239
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Country | US
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Telephone | 830-767-3082
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Fax | 830-767-3082
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | JERRY MCCLELLAN
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Credential |
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Telephone | 361-658-6986
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 144279
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License Number State | TX
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